Provider Demographics
NPI:1538252820
Name:MCCASLAN, SHANNON RAYBON (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:RAYBON
Last Name:MCCASLAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BEECH ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29842-8344
Mailing Address - Country:US
Mailing Address - Phone:803-867-3346
Mailing Address - Fax:
Practice Address - Street 1:350 AUSTIN GRAYBILL RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860-9251
Practice Address - Country:US
Practice Address - Phone:803-278-4272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC2546314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility